Behind the Rituals
All posts from: January 2012
Should drug administration be delegated to HCAs? What do you think?
A recent research study found nine out of 10 care home patients are regularly exposed to drug administration errors, with half deemed to be serious mistakes. Lack of time and interruptions were identified as a major cause rather than lack of training.
Drug rounds for 345 older patients were monitored in “real time” over three months using a new barcode medication administration system. The system identified when a potential mistake was about to be made, alerting the nurse or care assistant so that an error was averted.
Study author Deidre Wild, a senior resarch fellow at UWE, told Nursing Times both staff and managers needed to be more aware of the “high level of risk of medication error” that residents were routinely exposed to and “greater effort needs to be made to protect staff undertaking medication rounds from other work demands”.
Ms Wild added that the findings highlighted the potential for increasing patient safety by using technology such as that used in her study.
She said care staff in nursing homes might be able to use it to safely deliver more simple medications, so registered nurses had more time for higher level nursing activities. But she warned: “This should not be perceived as an opportunity to reduce valuable registered nursing time in favour of employing more care staff at less cost.”
Is home the best place to die? What do you think?
A new study based on Office for National Statistics (ONS) data has found more people are spending their final hours at home. The rise in home deaths appears to be most pronounced among people with cancer. The trend before this was a decline in deaths at home which almost halved from 1974 to 2003. Home deaths increased for the first time since 1974 among people aged 85 and over but this age group was the least likely to die at home of any adult age group over the study period.
Is epidural analgesia the best way to manage post-operative pain? What do you think?
Epidural analgesia has been shown to be an effective method of controlling post-operative pain after many different types of surgery. Level one evidence (systematic reviews) is available showing that epidural analgesia provides better post-operative pain relief than parenteral opioids such as morphine patient controlled analgesia systems (PCA) and subcutaneous or intramuscular morphine injections in major surgery in the thoracic abdominal and pelvic areas as well as orthopaedic and vascular surgery to the lower limbs. As well as providing better pain relief, epidural analgesia has also been shown to reduce post-operative complications such as incidence of respiratory failure, cardiovascular complications, gastrointestinal complications, renal insufficiency and the need for intubation and ventilation.
However, the use of epidural analgesia is not without risks. Problems relating to the drugs used (usually a local anaesthetic and/or an opioid) and the placement of a catheter into the epidural space need to be considered.
An anaesthetist will assess the benefits and risks of using epidural analgesia on an individual basis and will only place an epidural catheter if the benefits outweigh the risks.
It is also important that a patient receiving epidural analgesia is adequately monitored by nurses that are suitably trained to recognised, and respond promptly to, signs of the potentially life threatening complications of epidural analgesia.
In summary, epidural analgesia is the best way to manage post-operative pain when the benefits outweigh the potential risks and monitoring by suitably trained staff is available. What do you think?
Andrew Bird is a Nurse Specialist at the Pain Management Service.
Should nurses be taught how to make beds? What do you think?
In a recent discussion on twitter the topic of bed making came up. Comments were made about pleating sheets at the end of the bed, use of bed cradles and turning the open end of pillow cases away from the door.
Are these out dated practices or do they have a role in patient care? What do you think?
Are bedside handovers the best way of communicating with staff on the next shift? What do you think?